CDC Releases Controversial New Opioid Prescribing Guidelines

//CDC Releases Controversial New Opioid Prescribing Guidelines

CDC Releases Controversial New Opioid Prescribing Guidelines

According to the American Academy of Pain Medicine, pain now affects more people in the U.S than diabetes, heart disease, and cancer combined. While chronic pain has been around as long as humans, diagnosis of pain has grown due to increased awareness and better diagnostic instruments.

Along with an increase in diagnosis comes an increase in prescription opioids used to control pain.

Even though opioids are not recommended as a treatment for chronic pain, the number of prescriptions for this purpose rose sharply between the years of 2000 and 2009. When prescriptions rose, so, too, did opioid dependence, abuse, and overdose. In response to this, the Centers for Disease Control (CDC) have introduced new opioid prescribing guidelines aimed at sharply reducing the number of people who take opioids in the U.S. Not everyone is on board with these guidelines, and there is more than one perspective to this story. Pain News Network, in particular, has provided thorough coverage on the topic and we encourage you to read their take on the situation on their website as well.

At Pain Doctor, we feel that is important to note that, unlike the myths that would say otherwise, the vast majority of chronic pain patients are not taking opioids for pain management. Opioid prescriptions for non-cancer pain peaked in 2010 and then began to decline as healthcare providers and patients worked together to find alternate ways to treat chronic pain.

These new guidelines, based on opioid research from 2010, include the following provisions:

  • Use of non-pharmacological therapy as the “preferred” method of pain management
  • Drug testing before and during opioid use
  • Smaller doses for shorter periods of time (with “three days or fewer” being the general rule, and only for acute pain)

Other guidelines include specific instructions regarding counseling patients on the risks and potential benefits of opioids, careful and frequent monitoring of any changes in use of opioids (frequency or amount), and a thorough review of a patient’s medical history to predict any potential issues with previous substance abuse.

For some patients who do take opioids for pain management, these new guidelines are not welcome.

Many have tried other forms of non-pharmacological interventions with no success and worry that they will no longer be able to function if guidelines are tightened and prescriptions become harder to get. The CDC held a 48-hour online comment period, and many patients urged them to reconsider their new guidelines.

Writes one patient:

“It is already difficult to get my prescriptions that I have been safely using for years. If these additional restrictions of prescriptions, need for monthly doctor visits, etc. are put into place, I will only suffer more. Legitimate pain patients are not the problem, yet are greatly impacted by guidelines such as this.”

Another writes about the ease with which a friend turned to the street when legal opioids became harder to obtain:

“I have a friend who eventually became addicted to heroin when NY state made it hard for her to get tramadol. It was easier for her to get street drugs for her back injury pain.”

Patient advocates in the pain community also question the use of research they feel is misleading and wonder why the CDC is getting involved in the territory of the Food and Drug Administration. Janice Reynolds, a retired nurse and activist in the pain community, does not believe that the CDC’s involvement is warranted or that the new guidelines have the patient’s best interest at heart:

“The CDC knows nothing about pain management and possibly less about pharmacology, so why should anyone listen to them? Their complaints against opioids only increases the misery of people with pain and does little to prevent deaths as most people with an addiction to prescription medications obtain their meds not by legitimate prescriptions.”

Still another perspective is that of the prescribing doctors themselves. For pain management specialists, safely returning patients to a healthy, pain-free life is of paramount importance.

Many pain doctors have already put into place their own guidelines to assess options and appropriately prescribe opioids when the benefit outweighs the risk.

Pain Doctor currently uses a 12-step opioid therapy checklist that includes some aspects of the new guidelines, including taking a thorough patient history to identify potential dependence risks and appropriate complementary, non-pharmacological therapies where indicated. We believe in a calibrated, holistic approach to pain management, and for some of our patients that includes opioid therapies. Many doctors also voluntarily enact their own guidelines for prescribing opioids.

Until the guidelines are formally published, it is difficult to say what impact they may have on current practices, but in general, the vast majority of pain doctors want to keep their patients safe while treating their pain. If these new guidelines help to do that, pain doctors may embrace the changes.

Others are not fond of the wait-and-see approach. Because these guidelines were developed under somewhat secretive conditions, many community members are also not on board. Even though the guidelines are clear that they are aimed at non-cancer chronic pain, the American Cancer Society (ACS) sent the CDC a letter expressing their concerns about the guidelines and the implications in the language for cancer patients. They are concerned about the process from start to finish, saying that:

“[They] believe the proposed guidelines have the potential to significantly limit cancer patient access to needed pain medicines. [The American Cancer Society has] concerns about the lack of evidence on which the guidelines were based, the methodology used to develop the guidelines, and the transparency of the entire process.”

The Washington Post also initially withheld its support for the new guidelines but went on record in the opinion section on October 20th, stating that these new guidelines from such a respected national governmental body may be exactly what states need to decrease the number of opioid prescriptions overall:

“It’s true, as the [American Cancer Society] letter notes, that the CDC guidelines are more than mere suggestions and will influence ‘state health departments, professional licensing bodies or insurers.’ That is precisely why they can be so beneficial; until now, government, medicine and the private sector have too often underestimated the risks, individual and societal, of widespread opioid prescription. The CDC has the prestige and authority to correct the balance.”

It is important to understand that some of the guidelines are aimed at new patients only. For example, a patient currently taking over 90 milligrams of opioids daily for pain would not necessarily be held to the dosage limits set forth under the new guidelines.

As of October 21st, the CDC was still reviewing and revising the guidelines for prescribing opioids, and the final draft may be quite different due to feedback from patients, pain advocates, doctors, and community members. The Centers for Disease Control estimates publication of the guidelines early in 2016.

What do you think about the new rules?

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By | 2016-11-17T16:57:48-07:00 October 29th, 2015|Tags: , , , |10 Comments

About the Author:

Pain Doctor
Pain Doctor was created with one mission in mind: help and educate people about their pain conditions, treatment options and find a doctor who can help end their pain issues.

10 Comments

  1. Avatar
    Steve Silverwood November 2, 2015 at 5:55 pm

    If I wanted the CDC to treat my chronic pain, I’d move to Atlanta. In the meantime, I’m seeing an excellent pain-management specialist who is doing everything in his power to find the root cause of the pain and mitigate or eliminate it altogether. He’s working his behind off to achieve that goal, and I’m working with him to get there. In the meantime, the government needs to quit meddling in individual patient treatment by enacting such sweeping regulations, and let the doctors treat the patients based on their individual illnesses or injuries, without such broad-brush interference.

    • Pain Doctor
      Pain Doctor November 3, 2015 at 2:30 pm

      Hi Steve — we’re glad that you’ve found a caring and hard-working pain doctor who can help with your condition. Definitely follow along on the blog to see how this case continues to unfold, as these guidelines are still technically in draft form.

  2. Avatar
    fred November 11, 2015 at 7:31 am

    With slightly less than 5% of the world’s population the US consumes 80% of all opioids prescribed in the world. I am a chronic pain sufferer…I am 63 yrs old and in severe pain everyday and have been for almost 7 years…I have numerous “pain” issues but it is my cervical spine that is the most debilitated. I am also a huge believer in alternative pain management therapies. When my severe pain became constant I was dedicated to finding alternative strategies to my pain…I wanted to keep my opioid use to the barest minimum. I stopped smoking and improved my diet (real hard stuff). I exercise everyday, do PT stretches everyday, learned basic yoga and include it in my regimen, learned guided imagery/mindfulness techniques and do them every morning and before bed. Most importantly I think positively…no stinkin-thinkin and no awfulizing. It took 3 months to start to feel real results…but the alternative techniques started to pay of…and IT IS HARD WORK AND NOT EASY…but I kept at them. Seven years later I only need oxycodone every other day or two days, about 10 pills a week. Major cervical spine surgery has been put off because of all the exercise I do…my functionality is very good and that is the biggest reason for not needing surgery.
    Getting back to my first point about all the opioids the US consumes…sooo many pain advocates are saying there will be major increases in suicide, people will be miserable, and the sky will fall if pain patients need to reduce their opioids…well, how is 95% of the world managing on only 20% of the opioids that are prescribed? I AM ALL FOR OPIOID use when TRULY needed…I just think there are a bunch of folks out there that take the easier way to manage their pain- eat the opioids. The need to REALLY try alternative pain management techniques is far more warranted than most people admit to.

    • Pain Doctor
      Pain Doctor November 16, 2015 at 2:46 pm

      Your story is an inspiration Fred! Thank you for sharing it here.

  3. Pain Doctor
    Pain Doctor November 24, 2015 at 1:25 pm

    Thanks!

  4. Avatar
    Reba March 17, 2016 at 10:53 pm

    As a pain patient it has taken almost 10 years to find relief. I have done physical therapy, injections, breathing control, etc. I have severe tendonitis, osteoarthritis, and severe neuropathy. The oxycodone i take daily allows me to funcion normally instead of crying on my couch all day. I get to play with my kids, clean my house, and in general have a much higher quality of life. I don’t get high or loopy….I’m just able to do the things that most people do on a daily basis without tears in my eyes. It is really awesome to be able to play hide and seek with my kiddos instead of having to tell them mommy hurts too bad to get out of bed today.

    • Pain Doctor
      Pain Doctor March 22, 2016 at 12:29 pm

      Hi Reba — Thank you for sharing your story. There are patients who do find so much relief by using opioids.

  5. […] March 2016, the Centers for Disease Control and Prevention (CDC) released new opioid guidelines. A draft of new opioid guidelines was previously introduced in October of 2015 sparking immediate concern and controversy. The […]

  6. Avatar
    Raymond R October 31, 2017 at 8:32 am

    These new “quote on quote “guidelines” are already being adopted by doctors even with the great risk of harm and possible deaths for chronically ill patients who require these drugs to stay alive. For us, we already live only shells of our previous lives. Many of us will not have the will to stay alive under these conditions. It is criminal !!!! How many chronically ill people will have to die before “sane” doctors fight to stop this insanity? Apparently we would be better off as drug addicts, as that will be the only way to relieve the pain “not handled” properly by thousands of doctors afraid to stand up against the government!!!!

  7. Avatar
    MICHAEL SALATA March 14, 2018 at 2:30 pm

    I MYSELF HAVE OSTEOARTHRITUS, AND IT IS CRIPPLING. I JUST FOUND OUT TODAY THAT MY FENTYNAL PATCHES WILL BE CUT DOWN TO 25MG. FROM 100 MG.. I’VE BEEN ON THIS MEDICATION FOR YEARS… AND IT HELPS ME TO BE ABLE TO GET OUT OF BED.. AND HAVE A HALFWAY CHANCE AT A NORMAL PHYSICAL LIFE. WITH EVERY YEAR THAT PASSES, I GET MORE AND MORE CRIPPLED… AND MEDICAL CANNIBUS IS NOT A OPTION BECAUSE OF THE COST. SO WHAT ARE PEOPLE SUPPOSE TO DO. I SEE THIS PUSHING MORE AND MORE PEOPLE TO ILLEGAL OPIATES SUCH AS HEROIN. THAT IS WHAT SO MANY ARE DYING FROM THESE DAYS. I MYSELF AM DRUG TESTED AND USE MY MEDS AS PRESCRIBED. THE CDC HAS NO BUSINESS GETTING INVOLVED WITH THE FDA’S BUSINESS… AS SO MANY THAT COUNT ON THESE DRUGS TO LIVE SOME WHAT PAIN FREE… ARE GOING TO BE BEDRIDDEN.. SUCH AS MYSELF. I WILL BE CALLING MY STATE REP., AND COMPLAINING. IF A PAIN DOCTOR IS DOING HIS JOB AND MONITORING HIS PATIENTS.. AND YOU’RE NOT ABUSING YOUR MEDS (AS MY DOCTOR DOES A PILL COUNT AT ANYTIME DURING THE MONTH} WHAT IS THE PROBLEM??

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